[Viral diseases of the nervous system-Selected new and old viruses]. / Virale Erkrankungen des Nervensystems ­ ausgewählte neue und alte Viren.

Viral diseases of the nervous system are ancient and poliomyelitis was described in Egypt as early as 2000 BC. They can cause a wide range of neurological symptoms, such as meningitis, encephalitis, meningoencephalitis, Guillain-Barré-like syndrome and stroke, often leaving mild to severe residuals. Depending on the pathogen, the symptoms appear quickly within hours, or lead to increasing chronic symptoms within 1 week or months. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was newly identified in January 2020 and occurs worldwide, illustrates the sequelae of a phenomenon that has been known for centuries, the possible rapid spread of pathogen-related infectious diseases. Due to vaccination programs some pathogens are becoming rarer or are considered to be eradicated. Nevertheless, vaccination programs, especially in the poorer regions, are repeatedly interrupted, for example by wars. The most recent example is the interruption of vaccination against poliomyelitis in Ukraine. As life expectancy continues to rise and years of life lost to infectious diseases decrease, the new infectious disease threat is likely to come from emerging and re-emerging infections; however, according to a recent analysis of population data from 29 countries, life expectancy during the corona pandemic has decreased, e.g., by 28 months in the USA and by 6 months in Germany. Climate change, rapid urbanization and changing land-use patterns could increase the risk in the coming decades. In particular, the climate change can alter the spectrum of global pathogens and especially vector-borne infections can spread to new areas. A sustained increase in travel, trade and mobility enables the pathogens to spread quickly.

Flank Pain as a First Symptom of a Diffuse Midline Glioma.

Diffuse midline gliomas are a new entity in the WHO Classification of Tumors of the Central Nervous System, corresponding to grade 4 gliomas. The diagnostic pathognomonic feature is the presence of a H3K27M mutation. Although mainly seen in children, cases in adults have also been reported. The symptoms are highly variable and usually dependent on the location and extent of spinal cord compression.

[Transmission routes of neuropathogenic pathogens-Possible mechanisms of neuroinvasion]. / Übertragungswege neuropathogener Erreger ­ mögliche Mechanismen der Neuroinvasion.

Despite natural protective barriers, many human pathogens can penetrate the nervous system. The pathogens have developed sophisticated mechanisms to overturn the privileged immune status of the nervous system. The central nervous system (CNS) has natural barriers and immunological protective mechanisms, such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB), that prevent the invasion of pathogens. Bacteria enter the CNS, for example, through transcellular penetration, paracellular entry or via infected leucocytes from the peripheral circulation. Viruses can enter the CNS by hematogenous routes, by direct infection of endothelial cells or by paracellular passage between disrupted endothelial cells (cribriform plate). Also, a few "enhanced barriers", such as the cribriform plate and circumventricular organs (CVO) can serve as entry points for viruses. Viruses can also gain access to the CNS by infection of peripheral nerves. Importantly, most successful neurotropic pathogens are not necessarily restricted to a CNS entry portal. The majority of viral pathogens are of animal origin. Through sometimes sophisticated immune mechanisms for example in bats, highly pathogenic pathogens arose through cross-species transmission. In the last 50 years, various viruses, such as West Nile, Ebola, Marburg, Zika, Nipah and Hendra viruses have also been transmitted from animals to humans. Knowledge of these biological strategies is crucial to hinder, contain or prevent CNS infections.

Diabetes, Hypertension, Atrial Fibrillation and Subsequent Stroke-Shift towards Young Ages in Brunei Darussalam.

Southeast Asia harbors a young population of more than 600 million people. Socioeconomic transition within the last decades, driven by globalization and rapid economic growth, has led to significant changes in lifestyle and nutrition in many countries of this region. Hence, an increase in the number of non-communicable diseases is seen in most populations of Southeast Asia. Brunei Darussalam is the smallest country in this region, with a population of around 400,000 inhabitants. Vast hydrocarbon resources have transformed Brunei into a wealthy industrialized country within the last few decades. We compared the age distribution and prevalence of cardiovascular risk factors in ischemic stroke patients between the only stroke unit in Brunei Darussalam and a tertiary stroke center from Frankfurt/Germany. Between 2011 and 2016, a total number of 3877 ischemic stroke patients were treated in both institutions. Even after adjusting for age due to different population demographics, stroke patients in Brunei were younger compared to their German counterparts. The prevalence of hypertension and diabetes mellitus was significantly higher in young age groups in Brunei, whereas no difference was observed for older patients. The rapid socioeconomic transition might be a significant risk factor for the development of non-communicable diseases, including stroke.

Better be prepared: the spectrum of neuropsychiatric impairment among Libyan war victims transferred to Germany for trauma rehabilitation.

BACKGROUND: The current Libyan civil war has originated many casualties, imposing medical challenges. War injuries are complex, requiring specialized knowledge and interdisciplinary assessment for adequate patient and intercultural management. METHODS: This retrospective study analyzed records of 78 Libyan patients admitted from July 2016 to November 2017 to neurological and trauma surgical departments of Krankenhaus Nordwest, Frankfurt, Germany. Issues of system preparation of the hospital, demographics, injury patterns and therapies were analyzed. The chi-squared test was used to analyze differences in injury patterns in explosion and gunshot injuries. RESULTS: Seventy-seven of seventy-eight patients were male (mean age 30.6 years). The patients received primary and secondary treatment in Tunisia (n = 39), Libya (n = 36) and Turkey (n = 23). Forty-eight patients had gunshot injuries, 37 explosion injuries, 11 both. Preparation for management of injuries included hygienic and isolation protocols, organization of interpreters and intercultural training. Patients presented with a broad variety of neurological, psychiatric and trauma surgical injuries. Fifty-six patients had sensory, 47 motor deficits. Nine reported headache, 5 vertigo, 13 visual impairment, 28 psychiatric symptoms. Eighteen patients had central nervous damage, 50 peripheral nervous damage. Central nervous damage was significantly more common in gunshot than explosion injuries (p = 0.015). Peripheral nervous damage was more common in explosion than gunshot injuries (p < 0.1). Fifty-one patients had polytrauma and 49 suffered from fractures. Therapy included surgical interventions (n = 56) and physiotherapy. Structured rehabilitation programs were often indicated. CONCLUSION: Specialized knowledge about war injuries and their management including hospital preparation and planning regarding infrastructure may be required anytime. Injuries include a broad variety of neurological, psychiatric and trauma surgical injuries. Therefore, an interdisciplinary approach is crucial.

[Meningitis, Meningoencephalitis - A Chameleon in (Emergency) Medicine]. / Meningitis/Meningoenzephalitis ­ ein Chamäleon in der Medizin.

A wide range of pathogens can cause meningitis or meningoencephalitis.Guiding symptoms of meningitis are headache, fever, nausea, vomiting and meningism.Guiding symptoms of meningoencephalitis are headache, fever, qualitative or quantitative disturbances of consciousness, signs of meningism are possible, optional focal neurological signs can occur.Crucial prognostic factor in treatment of acute meningitis and meningoencephalitis is rapid diagnosis and early initiation of therapy. An early start of therapy is crucial. In addition to rapid pathogen-specific treatment, specialized neurological intensive care medicine is life-saving.

Brunei epidemiological stroke study: patterns of hypertension and stroke risk.

OBJECTIVES: Hypertension is the most important known risk factor for cardiovascular diseases. A cross-sectional study was conducted in Brunei Darussalam to estimate the prevalence of hypertension and its association with socioeconomic and life-style factors and impact on stroke incidence. METHODS: Five thousand and sixty-three participants aged above 18 years from 2103 randomly selected households in the Brunei-Muara district of Brunei Darussalam were surveyed. Hypertension was defined as mean SBP at least 140 mmHg, DBP at least 90 mmHg, or taking antihypertensive medication and blood pressure was measured twice. Logistic regression models are used to analyze the association between hypertension/medication for hypertension and sex, age, overweight, education, smoking, family history of hypertension, and employment. RESULTS: A total of 48.3% [95% confidence interval (CI): 46.9-49.7%] of all respondents were identified as hypertensive. Prevalence of hypertension was higher in men (52.8%; 95% CI: 50.7-54.9%) compared to women (45.0%; 95% CI: 43.2-46.8%) and women seek treatment more often than men. Age, overweight, lower levels of education, and a family history of high blood pressure are positively associated with the prevalence of hypertension. The prevalence of overweight (57.3%) and obesity (23.7%) is high and the attributable risk of hypertension for stroke is large. CONCLUSION: The prevalence of hypertension in Brunei is high in both women and men. Information campaigns and prevention programs are needed to be able to cope with the increasing problem of hypertension and resulting diseases like stroke in Brunei in the near future.

Immortalized endothelial cell lines for in vitro blood-brain barrier models: A systematic review.

Endothelial cells play the most important role in construction of the blood-brain barrier. Many studies have opted to use commercially available, easily transfected or immortalized endothelial cell lines as in vitro blood-brain barrier models. Numerous endothelial cell lines are available, but we do not currently have strong evidence for which cell lines are optimal for establishment of such models. This review aimed to investigate the application of immortalized endothelial cell lines as in vitro blood-brain barrier models. The databases used for this review were PubMed, OVID MEDLINE, ProQuest, ScienceDirect, and SpringerLink. A narrative systematic review was conducted and identified 155 studies. As a result, 36 immortalized endothelial cell lines of human, mouse, rat, porcine and bovine origins were found for the establishment of in vitro blood-brain barrier and brain endothelium models. This review provides a summary of immortalized endothelial cell lines as a guideline for future studies and improvements in the establishment of in vitro blood-brain barrier models. It is important to establish a good and reproducible model that has the potential for multiple applications, in particular a model of such a complex compartment such as the blood-brain barrier.